Surgical Setting Research Articles

Inherited Disorders of the Fibrinolytic Pathway: Pathogenic Phenotypes and Diagnostic Considerations of Extremely Rare Disorders

AbstractFibrinolysis is initiated by the activation of plasminogen to plasmin via tissue-plasminogen activator (tPA) and urokinase-plasminogen activator (uPA); plasmin then converts fibrin to fibrin degradation products (FDPs). The antifibrinolytics counterbalancing this system include plasminogen activator inhibitor-1 (PAI-1), which inhibits tPA and uPA, α-2 antiplasmin (α2AP), which inhibits plasmin, and thrombin activatable fibrinolysis inhibitor, which inhibits the conversion of fibrin to FDP. Inherited disorders of the fibrinolytic pathway are rare and primarily have hemorrhagic phenotypes in humans: PAI-1 deficiency, α2AP deficiency, and Quebec platelet disorder. Patients with these disorders are usually treated for bleeds or receive prophylaxis to prevent bleeds in the surgical setting, with pharmacological antifibrinolytics such as aminocaproic acid and tranexamic acid. Disorders of the fibrinolytic pathway with fibrin deposition are extremely rare, mostly noted in patients with plasminogen deficiency, who have more recently benefited from advances in human plasma-derived plasminogen concentrates administered intravenously or locally. These disorders can be very difficult to diagnose using conventional or even specialized coagulation testing, as testing can be nonspecific or have low sensitivity. Testing of the corresponding protein's activity and antigen (where applicable) can be obtained in specialized centres, and routine laboratory measures are not diagnostic. Genetic testing of the pathogenic mutations is recommended in patients with a high suspicion of an inherited disorder of the fibrinolytic pathway.

A frailty census of older adults in the emergency department and acute inpatient settings of a model 4 hospital in the Mid-West of Ireland

Abstract Background Frailty is a risk factor for presentation to the ED, in-hospital mortality, prolonged hospital stays and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty. The aim of this cross-sectional study was to establish the prevalence of frailty and co-morbidities among older adults in an acute hospital setting. Methods Data collection was undertaken by clinical research nurses and advanced nurse practitioners experienced in assessing older adults. All patients aged ≥ 65 years and admitted to a medical or surgical inpatient setting between 08:00 and 20:00 and who attended the ED over a 24-h period were screened using validated frailty and co-morbidity scales. Age and gender demographics, Clinical Frailty Scale (CFS), Charlson Co-morbidity Index (CCI) and admitting specialty (medical/surgical) were collected. Descriptive statistics were used to profile the cohort, and p values were calculated to ascertain the significance of results. Results Within a sample of 413 inpatients, 291 (70%) were ≥ 65 years and therefore were included in the study. 202 of these 291 older adults (70%) were ≥ 75 years. Frailty was investigated using validated clinical cut-offs on the CFS (not frail < 5; frail ≥ 5). Comorbidities were investigated using the Charlson Comorbidity Index (mild 1–2; moderate 3–4; severe ≥ 5). The median CFS was 6 indicating moderate frailty levels, and the median CCI score was 3 denoting moderate co-morbidity. In the inpatient cohort, 245 (84%) screened positive for frailty, while 223 (75%) had moderate-severe co-morbidity (CCI Mod 3–4, severe ≥ 5). No significant differences were observed across genders for CFS and CCI. In the ED, 81 patients who attended the ED were ≥ 65 years. The median CFS was 6 (moderate frailty), and the median CCI was 5 (severe co-morbidity level). Seventy-four percent (60) of participants screened positively for frailty (CFS ≥ 5), and 31% (25) had a CFS of 7 or greater (severely frail). Ninety-six percent (78) of patients had a moderate-severe level of comorbidity. No significant associations were found between the CFS and CCI and ED participants age, gender, and medical/surgical speciality usage. Conclusion There is a high prevalence of frailty and co-morbidity among older adults who present to the ED and require inpatient care. This may contribute to increased waiting times, lengths of stay, and the need for specialist intervention. With an increased focus on the integration of care for older adults across care transitions, there is a clear need for expansion of frailty-based services, staff training in frailty care and multidisciplinary team resources across the hospital and community setting.

Caring for patients with diabetes in the outpatient surgical setting: current recommendations and controversies.

Perioperative outpatient (ambulatory) care of the adult patient with diabetes requires unique considerations that vary from the inpatient setting. This review highlights specific pre, intra, and postoperative care steps for patients with diabetes undergoing ambulatory surgery, summarizing recent clinical trials, expert reviews, and emerging evidence. There is a paucity of evidence examining optimal diabetes management in the outpatient setting. Currently, there are limited studies regarding preoperative management of oral hypoglycemic agents, home insulin, and carbohydrate-containing beverages. Future research needs to specifically examine chronic blood glucose control, day of surgery targets, effective home medication management and the risk of perioperative hyperglycemia in ambulatory surgery. Education, protocols and resources to support the care of perioperative patients in the outpatient setting will aid providers on the day of surgery and provide optimal diabetes care leading up to surgery.

Liposomal Bupivacaine Does Not Decrease Postoperative Pain in Patients with Intracapsular Femoral Neck Fracture Treated with Hemiarthroplasty: HEAT-A Randomized, Controlled Trial.

Liposomal bupivacaine (LB) is a long-lasting local anesthetic agent that was developed for use in the surgical setting to help manage postoperative pain. The objective of this study was to evaluate the effect of LB on postoperative pain, function, and overall hospital course in patients with intracapsular hip fractures who were treated with hip hemiarthroplasty. This was a single-center, randomized prospective double-blinded study of 50 patients with an isolated intracapsular femoral neck fracture who were treated with hip hemiarthroplasty from 2018 to 2022. The study group consisted of 25 patients who were treated with intraoperative LB and bupivacaine hydrochloride injections, while the control group consisted of 25 patients who were treated with intraoperative bupivacaine hydrochloride injections only. Primary outcomes were a visual analog scale (VAS) score for pain, total morphine milligram equivalents (MME), delirium, and time to ambulation with physical therapy. No significant differences between the study and control groups were found in any of the outcomes measured. Most notably, there were no differences in the average postoperative pain score (VAS, 2.26 versus 2.7; p = 0.34), total MME used postoperatively (11.73 versus 9.98 MME; p = 0.71), and postoperative day of discharge (4.00 versus 3.88 days; p = 0.82). The results of our study suggest that use of LB is not associated with substantially improved postoperative pain or function or with a shorter hospital course following hip hemiarthroplasty for a femoral neck fracture. Given the higher cost of LB compared with standard postoperative pain modalities, it is worth questioning its use in the setting of geriatric hip fractures. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Mpox and Surgery: Protocols, Precautions, and Recommendations.

Mpox, also known as Monkeypox, is an infectious disease known to spread via direct contact and fomites, which poses a significant contagion risk in surgical settings and may increase the challenges already posed by COVID-19. Within the three years following the outbreak of Mpox, we conducted a review of the impact of Mpox on surgical practice. We searched Pubmed/Medline and Scopus, focusing on original studies and case reports in English or German. Our search terms included "Mpox", "Monkeypox", and "Surgery". Out of 60 clinical or epidemiological studies, as well as expert opinions, brief reports, and pertinent literature reviews, eight were included after full-text assessment. We also incorporated two pertinent literature reviews, including a total of 10 papers, in this analysis. The main topics addressed by the literature are 1. manifestations of Mpox for surgical consideration or urgent management, for which it is important to consider whether a surgical approach is needed to address long-term Mpox-related lesions and 2. infection control in surgical settings, especially considering its impact on elective surgery and the well-being of healthcare workers. Mpox could affect surgical services and access to operating theaters. Unlike COVID-19, Mpox, compared to initial concerns, has not substantially compromised surgical delivery. However, limited reports exist on the surgical impact of Mpox. It is crucial to involve surgeons in Mpox diagnosis, educate surgical practitioners on its mimicry of common surgical conditions, enhance infection control during surgery, and ensure access to corrective surgery as a means of tackling the stigmatization associated with Mpox and sexually transmitted diseases in general.

Enhancing surgical navigation: a robust hand-eye calibration method for the Microsoft HoloLens 2.

Optical-see-through head-mounted displays have the ability to seamlessly integrate virtual content with the real world through a transparent lens and an optical combiner. Although their potential for use in surgical settings has been explored, their clinical translation is sparse in the current literature, largely due to their limited tracking capabilities and the need for manual alignment of virtual representations of objects with their real-world counterparts. We propose a simple and robust hand-eye calibration process for the depth camera of the Microsoft HoloLens2, utilizing a tracked surgical stylus fitted with infrared reflective spheres as the calibration tool. Using a Monte Carlo simulation and a paired-fiducial registration algorithm, we show that a calibration accuracy of 1.65mm can be achieved with as little as 6 fiducial points. We also present heuristics for optimizing the accuracy of the calibration. The ability to use our calibration method in a clinical setting is validated through a user study, with users achieving a mean calibration accuracy of 1.67mm in an average time of 42s. This work enables real-time hand-eye calibration for the Microsoft HoloLens2, without any need for a manual alignment process. Using this framework, existing surgical navigation systems employing optical or electromagnetic tracking can easily be incorporated into an augmented reality environment with a high degree of accuracy.

Synergistic Procoagulant Mechanism and Application of Kaolin-Zeolite Composite Hemostat for Effective Hemorrhage Control.

Achieving timely and effective hemorrhage control is imperative for the survival of individuals with severe bleeding. Hemostatic materials, by enhancing the natural cell-based coagulation response, are essential tools in modern and military medical practice for controlling bleeding, especially in emergency and surgical settings. Here, we report a new type of composite hemostatic material with two different aluminosilicate-based components, kaolin and zeolite, which synergistically work together in different stages of the coagulation cascade reactions. Kaolin can effectively activate the clotting factor FXII in the early stage, and zeolite can accumulate and assemble FXa and FVa on its surface and thereafter lead to the formation of highly active thrombin in the later stage. The synergistic action mechanism between kaolin and zeolite significantly boosts the levels of FXIIa and FXa, and it also greatly enhances plateau thrombin activity. For practical application, a kaolin-modified zeolite gauze is fabricated, and it demonstrates excellent hemostatic effectiveness. Compared to the combat gauze currently used in front-line treatment, it reduces blood loss by 75% and shortens hemostasis time by 33% in a rabbit femoral artery injury model. In addition, this kaolin-zeolite gauze has no heat release problem and a nearly zero particle shedding rate, which greatly decreases the safety risk compared to current commercial inorganic-based hemostatic gauzes.

FP5.14 - Enhancing Patient Communication in Surgical Care: an Audit of Practice at a DGH

Abstract Aims This audit aimed to evaluate current communication standards at a DGH (based on inpatient feedback) and assess the alignment with NICE Guidelines for improving the experience of care in adult NHS-services. The standards assessed included: providing clear information on diagnosis, oral and written communication, and communication in the presence of family or next of kin. Methods Inpatient feedback on surgical wards was collected to assess guideline adherence, with a pre-intervention survey designed to assess opinions before implementing an intervention. Two assessment cycles were conducted, with 12 responses in Cycle 1 (1-15 Nov 2023) and 13 responses in Cycle 2 (16-30 Nov 2023). The intervention included providing clear written information on imaging results and ongoing plans, and encouraging patients to use an information sheet throughout their admission, which could also be relayed to family members. Results Pre-intervention data revealed a diverse age distribution, predominantly in the 55-64 age group. Understanding of diagnosis varied pre-intervention but showed improvements post-intervention. Post-intervention, the majority (n=9) felt the information was appropriately pitched. Thirteen respondents received accessible information, finding the universally distributed information sheet helpful. A written response highlighted its utility in explaining clinical information to families. Healthcare professionals received improved 'clarity' and 'helpfulness' ratings post intervention, indicating positive outcomes. Conclusions Effective communication is integral to exceptional patient care. This audit underscores the potential to enhance patient understanding, alleviate concerns, and improve communication in surgical settings. The intervention, a simple information sheet, proved effective and emphasised the need for accessible, clear and standardised patient communication.

SP9.5 - Peri-operative Comprehensive Geriatric Assessment (CGA): A new benchmark for Acute General Surgery patients

Abstract Aims More than 50% of patients undergoing emergency general surgery are over 65 years of age. NICE guidelines emphasise frailty assessment in acute surgical settings, particularly in the preoperative period. Similarly, the Emergency Laparotomy and Frailty (ELF) study showed associations between frailty (CFS ≥ 5) and 90-day mortality, increased complication and length of hospital stay in older emergency laparotomy patients. NELA best practice tariff (BPT) April 2023 heavily focuses on perioperative team involvement in frailer, older patients. This is an audit from a city teaching hospital, with a surgical liaison team against standards set by NELA. Methods Review of patients aged ≥ 65 undergoing emergency laparotomies between August and November 2023 (pre-intervention) then December and January 2024 (post-intervention). Data collected includes whether patients had a documented frailty score, a clearly documented CPR decision & treatment escalation plan (TEP), pre- or post-operative medical review, and advanced-care planning (ACP) post-operatively. Intervention included dedicated members of surgical liaison team following patients throughout admission, weekly meetings to discuss laparotomy patients, older patient template being created capturing ceilings of care, frailty score, and social history. Results Post intervention, improvement in clear documentation regarding escalation, frailty level. Greater level of MDT collaboration with regards to older patients undergoing laparotomies. Conclusion Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Even a basic surgical liaison service can achieve high levels of compliance with a few simple strategies, resulting in better outcomes for patients as well as financial benefits for Trusts.

Investigation the Frequency of Fungal Contamination in Surgical Instruments

Background: Fungal contamination of surgical instruments poses a significant risk to patient safety, potentially leading to surgical site infections and other severe complications. By examining contamination levels both immediately after opening sterile sets and after two hours of environmental exposure, it becomes possible to assess contamination reduction strategies. Objectives: The aim of this study was to identify which instruments and operating rooms were most affected by fungal contamination. Understanding the extent of this contamination is critical to developing more effective sterilization protocols, improving infection control practices, and ultimately enhancing patient safety in surgical settings. Methods: This study was conducted on surgical instruments at Ali ebn Abi Talib Zahedan Hospital in 2023, across seven operating rooms (emergency, general surgery, gynecology, and urology). Samples were randomly collected under sterile conditions to prevent external contamination. The collected samples were cultured in Sabouraud Dextrose Agar (SDA), and data were analyzed using SPSS version 26. Results: The findings revealed that different surgical instruments, such as Pinzette (without teeth), Allis forceps, Babcock forceps, curved clamps, Gully pots, receivers, retractors, ring forceps, and towel clamps, were contaminated with fungal pathogens within two hours of opening the sterile sets. The highest contamination rates were observed in general surgery (39%), followed by emergency (29%), urology (21%), and gynecology (11%) rooms. The most common fungal contaminants were Aspergillus spp., yeast, and Penicillium spp. Conclusions: This study highlights the challenge of maintaining sterility in surgical environments post-sterilization, as fungal contamination reappeared on surgical instruments within two hours despite the initial sterilization. These findings emphasize the need for enhanced infection control measures, advanced environmental controls, and regular monitoring to reduce the risks associated with fungal contamination in surgical settings.

The effect of dexmedetomidine on emergence delirium of postanesthesia events in pediatric department: A systematic review and meta-analysis of randomized controlled trials.

Emergence delirium (ED) is a common occurrence in pediatric postanesthesia events, leading to negative outcomes. Dexmedetomidine (DEX), as an anesthesia adjuvant, has shown promise in preventing ED in adult surgeries, and it has been increasingly used in pediatric surgical settings. However, its effectiveness in other postanesthesia events, such as MRI examinations and ambulatory surgery centers, remains unclear. This meta-analysis aims to assess the safety and efficacy of DEX in preventing ED in various pediatric postanesthesia events beyond surgery. Prospective randomized controlled trials were searched in Pubmed, Web of Science, and EBSCO until October 13, 2023. Comparisons were made between DEX and other sedatives or analgesics in different postanesthesia events (including surgery operations, the examination of MRI, day surgery, and invasive action). Subgroup analyses were conducted based on drug delivery methods, medication timing, DEX dosages, use of analgesics, event types, and recovery time. A total of 33 trials involving 3395 patients were included. DEX significantly reduced the incidence of ED (odds ratios [OR] = 0.23, 95% confidence interval [CI]: 0.19-0.27, I2 = 37%, P < .00001). Intranasal delivery of DEX was the most effective (OR 0.18, 95% CI: 0.10-0.32, P < .00001, I2 = 0%). DEX also showed benefits in day surgery and mask insertion events (OR 0.30, 95% CI: 0.14-0.26, P = .001, I2 = 0%). DEX demonstrates superior efficacy in preventing ED in pediatric postanesthesia events compared to other sedatives and analgesics. Its use is recommended in various settings for its safety and effectiveness in managing ED.

Is Taurolidine Irrigation Effective in Preventing Surgical Site Infection during Fracture Surgery?

Taurolidine, known for its broad-spectrum antimicrobial properties and low toxicity, has shown promise in reducing infections in various surgical settings. However, it has not been extensively evaluated in orthopedic surgery. This study assessed the efficacy of taurolidine irrigation in reducing surgical site infections in patients undergoing ankle fracture surgery. A retrospective review was conducted for patients >20 years old who underwent ankle fracture surgery between March 2016 and March 2023, with follow-ups exceeding 6 months. Patients were classified into the following two groups: those who underwent normal saline (NS) irrigation and those who underwent taurolidine irrigation. Minor infections were defined as requiring additional oral antibiotics postoperatively, while major infections were characterized by hospitalization or reoperation due to infection within 3 months. Of 844 patients, 688 were included. The taurolidine group (n = 328) had a significant reduction in minor infections (7.3% vs. 22.5%, odds ratio = 0.410, p = 0.028) compared to the NS group (n = 360). Major infections were fewer in the NS group (1.2% vs. 0%, p = 0.051), but the number of cases was too small for reliable analysis. Taurolidine irrigation significantly reduces the occurrence of minor infections in ankle fracture surgeries when compared to normal saline irrigation.

Advanced Practice Providers in Pediatric Surgery: A 10-Year Analysis of Clinical Productivity

Introduction: Advanced practice providers (APPs) are integral to nonsurgical and surgical fields. In surgical settings, APPs work autonomously alongside surgeons to enhance continuity of care. While small-scale studies across various surgical specialties have explored APP utilization, literature specific to the pediatric population is limited. This study assesses the impact of increased APP utilization on productivity within one of the largest pediatric surgery departments in the United States. Methods: Data was sourced from the Surgery Department Executive Committee (SDEC) annual reports. Descriptive analyses were performed to delineate trends in clinical volumes, OR cases, gross charges, work relative value units (wRVUs), and provider full-time equivalents (FTEs) between October 2011 and September 2023. Secondary analyses were performed from 2016 to 2023, after APP roles were refined in each division. Results: Since 2012, an upward trend is observed in total clinic visits, total OR cases, and OR cases per MD. In 2016, APPs saw 1 clinic patient for every 2.2 seen by MDs, decreasing to a 1:1 ratio by 2023. The MD surgical conversion rate has increased by 20.5% since 2016, while the conversion rate per total clinic volume has decreased by 7.3% over the same period. Total wRVUs and gross charges increased across the department and per provider, despite fewer overall providers since 2021. Conclusion: Increased utilization of APPs within the department of surgery may enhance procedural productivity for surgeons while ensuring continued patient access to care. This study highlights the importance of developing care models that optimize the full skillset of APPs.

Automated classification of mandibular canal in relation to third molar using CBCT images

Background Dental radiology has significantly benefited from cone-beam computed tomography (CBCT) because of its compact size and low radiation exposure. Canal tracking is an important application of CBCT for determining the relationship between the inferior alveolar nerve and third molar. Usually, canal tacking is performed manually, which takes a lot of time. This study aimed to develop an artificial intelligence (AI) model to automate classification of the mandibular canal in relation to the third molar. Methods This retrospective study was conducted using 434 CBCT images. 3D slicer software was used to annotate and classify the data into lingual, buccal, and inferior categories. Two convolution neural network models, AlexNet and ResNet50, were developed to classify this relationship. The study included 262 images for training and 172 images for testing, with the model performance evaluated by sensitivity, precision, and F1 score. Results The performance of the two models was evaluated using a 3 × 3 confusion matrix, with the data categorized into 3 clases: lingual, buccal, and inferior. The mandibular canal and third molar have a close anatomical relationship, highlighting the need for precise imaging in dental and surgical settings. To accurately classify the mandibular canal in relation to the third molar, both AlexNet and ResNet50 demonstrated high accuracy, with F1 scores ranging from 0.64 to 0.92 for different classes, with accuracy of 81% and 83%, respectively, for accurately classifying the mandibular canal in relation to the third molar. Conclusion The present study developed and evaluated AI models to accurately classify and establish the relationship between the mandibular canal and third molars using CBCT images with a higher accuracy rate.

Assessing Healthcare Equity in Orthopaedic Surgery: An Analysis of Over 24,000 Surgical Cases.

Health disparities have been widely studied in the primary care and surgical settings. The purpose of this study was to examine surgical access disparities for orthopaedic surgical cases performed at a large academic health center by comparing the relationship between patient demographic factors and surgical wait time. A total of 24,778 orthopaedic surgical cases from 2018 to 2022 at a public, tertiary care, Level I trauma center were retrospectively analyzed to assess for surgical timing disparities based on patient-specific factors, including race, sex, language, and socioeconomic status. Elective surgical cases were completed with an average surgical wait time of 28.11 ± 26.34 days. Urgent surgical cases were completed with an average surgical wait time of 1.23 ± 1.50 days. Patient race, sex, language, and socioeconomic status had no effect on surgical wait time for urgent case scheduling. Female patients had longer average wait times in elective cases, whereas race had a weak association with increased wait time. Two-factor interaction analysis showed no multifactorial effects of patient demographic factors on surgical wait time. Patient race and socioeconomic status were associated with increased distance from surgical sites, although increased distance did not correlate with increased surgical wait time. Patient demographic factors did not demonstrate clinically notable associations with surgical timing in this patient cohort, in contrast to previous studies demonstrating the effects of race and socioeconomic status on healthcare outcomes and access. Race and socioeconomic status did correlate with increased distance from surgical centers although distance from surgical sites did not correlate with surgical wait time. This contributes to previous literature on healthcare equity and indicates that surgical wait time may not contribute to the known healthcare inequalities seen in minority and marginalized patients.

Vibrational Feedback for a Teleoperated Continuum Robot with Non-contact Endoscope Localization

Abstract Limited or absent haptic feedback is reported as a factor hindering the continued adoption of surgical robots. This article presents a proof of concept for vibrotactile feedback integrated into a continuum robot to explore whether such feedback improves spatial perception in surgical settings. The robot is equipped with a capacitive sensor for noncontact endoscope localization, enabling spatial awareness of the robot’s tool center point (TCP) within the surgical environment. The data from the sensor is processed and transmitted to a bracelet worn by the user, which generates vibrotactile feedback. The bracelet contains four vibration motors providing tactile cues for navigation and positioning of the robot’s TCP. All subsystems are integrated into a unified system to deliver vibrotactile feedback to the user. When the user maneuvers the TCP of the robot near an object, they receive vibrotactile feedback via the bracelet. Thereby, the intensity of vibration increases as the TCP approaches the object, and the direction of the obstacle is mapped on the bracelet. Initial functional tests were performed and prove the functionality of the proposed system.

Can a New, Satellite Inpatient Hospital Maintain the Efficiency of an Ambulatory Surgery Center with No Difference in Patient-Reported Outcomes?: A Prospective Study

BackgroundPrevious research has found that anterior cruciate ligament (ACL) reconstructions performed at Ambulatory Surgery Centers (ASCs) are more time efficient. However, recent literature investigating this phenomenon within the pediatric population is limited and primarily retrospective. The goal of this study was to prospectively compare the operating room (OR) efficiency of pediatric ACL reconstructions performed across different surgical settings. MethodsAdolescent patients (12-18 years) undergoing ACL reconstruction by a single surgeon were prospectively enrolled from 2020-2024. Patients were cohorted based on the location of their surgery at one of three sites: 1) a traditional, tertiary-care academic hospital, 2) hospital-owned ASCs, or 3) a satellite inpatient hospital that was built and connected to an ASC in January 2022. Patient preoperative, surgical, and postoperative data was collected, and surgical efficiency was compared across surgical sites using a variety of metrics. Patient-reported outcomes (PROMs) were collected using the Pedi-FABS and Pedi-IKDC questionnaires. ResultsA total of 115 patients (56.5% female, mean age 15.4 +/- 1.7 years) met inclusion criteria and were enrolled. 31 patients (27.0%) had ACL reconstructions at the main inpatient hospital, 36 (31.3%) at hospital-owned ASCs, and 48 (41.7%) at the new satellite inpatient hospital. When controlling for concomitant procedures, regional anesthesia type, and staff, there was a significant difference in total OR in-room, anesthesia induction, surgery preparation, surgery duration, and dressing application/wake-up times among the three cohorts (p<0.001). Both the ASCs and the satellite inpatient hospital had shorter total OR in-room and surgery duration times than the main inpatient hospital (p<0.001). There were no differences in patient-reported outcomes among the three cohorts (p>0.05). ConclusionsAdolescent ACL reconstructions performed at either an ASC or a satellite inpatient hospital were more time efficient than those performed at a traditional, main inpatient hospital with no differences in PROMs. Institutions should consider implementing strategies used at ASCs, such as standardized surgical teams, at main hospitals to increase efficiency. Level of EvidenceII (Prospective Cohort Study)

Association between race, post operative outcomes and costs for inpatient and outpatient total joint arthroplasty

Background: While factors like readmissions and costs have been compared between care settings for total joint arthroplasty, little research has analyzed readmission and cost differentials stratified by patient characteristics within each care setting. This study will unveil such differences with regard to race and co-morbidity status. Methods: Retrospective binary-logistic-regression and OLS regression were employed on de-identified inpatient and outpatient orthopedic surgical data gathered from an academic medical center from 2016-2020. Data elements included surgical setting, covariates (age, gender, race, obesity, smoking status), Elixhauser comorbidity indices, surgical times, and cost. Results: African American (AA) inpatients had significantly greater odds of return to hospital (7 day, 30 day, 90 day) when compared to Caucasian inpatients (P&lt;0.01-0.05). AA inpatients less than 65 yr old had significantly increased odds of returning to the hospital and getting readmitted (7 day, 30 day) when compared to AA inpatients older than 65 and all Caucasian inpatients (P&lt;0.05). Asian inpatients had significantly greater odds of 90 day return (P&lt;0.05). AA outpatients had significantly greater odds of 30 day return when compared to Caucasian outpatients. Age and time spent in the OR directly correlated with increased costs (P&lt;0.05, P&lt;0.01). Increased comorbidities correlated with increased costs only for inpatients (P&lt;0.05). Conclusion: All AA patients, but specifically those less than 65 yr of age, experience increased readmissions and returns to hospital following the same procedure when compared to their Caucasian counterparts. Medicaid patients experience greater costs, Medicare-Managed patients experienced decreased costs. Co-morbidites were directly related to costs in the inpatient setting.

VE58 Robot-assisted partial nephrectomy for upper pole renal masses using the Hugo™ Ras System: Tips and tricks for flawless surgical setting.

VE58 Robot-assisted partial nephrectomy for upper pole renal masses using the Hugo™ Ras System: Tips and tricks for flawless surgical setting.

Clinical value of MR defecography: What additional knowledge is provided by the radiologist to the surgeon?

PurposeTo evaluate the clinical value of MR defecography in supporting surgical decision-making and management strategies in a consecutive series of patients. Material and methodsA consecutive series of patients with clinical suspicion of pelvic disorders who underwent MR defecography at a single university hospital from January 2021 to June 2024 were included. MR defecography was performed at rest (axial/sagittal and coronal T2-weighted sequences), during squeezing, straining, and evacuation (dynamic sagittal T2-weighted sequences). An expert surgeon assessed his satisfaction about the diagnostic information given by the prospective radiological report as: 1: insufficient, 2: sufficient, 3: good, 4: excellent. For patients who underwent surgery, the same surgeon assessed the usefulness of the MR defecography, using a score from 1 to 4 (1: discordant findings, useless exam; 2: concordant findings without new information; 3: concordant findings, useful new information; 4: concordant findings, extremely useful new information). ResultsA total of 218 patients (age 27 − 79, mean 60 ± 11; 193 females and 25 males) entered the analysis. For 211 of them (97 %), the radiologist was able to evaluate the images and determine an MR defecography-based diagnosis; in 7 patients (3 %), a diagnosis was not provided due to exam interruption for low patient’s compliance. In 195/211 patients (92 %), the radiological diagnosis matched the clinical suspect that prompted the examination. The satisfaction about the diagnostic information given by the radiological report of the 211 exams was assessed by the surgeon as follows: excellent (n = 99, 47 %), good (n = 48, 23 %), sufficient (n = 35, 16 %), and insufficient (n = 29, 14 %). Out of 211 patients, 73 (34.6 %) underwent surgery. MR defecography provided concordant findings with relevant additional information in 63 (86.3 %), concordant findings with additional information in 3 (4.1 %), concordant findings without additional information in 4 (5.5 %), and discordant findings in 3 (4.1 %). ConclusionsThe diagnostic information prospectively provided by MR defecography resulted to be good or excellent in 70 % of the patients, adding clinical value in the preoperative surgical setting in 86 % of those patients who underwent surgery.